Antibiotics management: the pharmacist’s role

teaserRay Fitzpatrick,
Consultant Editor

Antibiotics represent a significant proportion of a hospital’s drug expenditure, not only because there is a need to use more potent agents, but also because the IV route is often required. Therefore, as hospital pharmacists, we should be taking a special interest in this therapeutic group of medicines. Furthermore, anti‑biotics have recently become the focus of attention because of the emergence of resistant organisms. In this edition of HPE, we carry two articles on the subject, which approach the issue from different perspectives, yet reach the same conclusion.

The article by Kathleen Bamford sets the scene in relation to antibiotic resistance and the therapeutic dilemma facing clinicians of either using suboptimal treatment when prescribing empirically, and possibly delaying recovery, or using expensive potent agents too soon, which not only wastes resources, but potentially increases the resistance problem. What is pleasing to note is that, although written by a microbiologist, the author acknowledges the contribution of the pharmacist as part of the multidisciplinary team tackling the problem of antibiotic resistance. The article by Eyal Schwartzberg describes in more detail how the pharmacist can apply his or her pharmaceutical knowledge to the more cost-effective use of antibiotics. Our understanding of the pharmacokinetic properties of antibiotics can help us contribute to optimum use: by interrogating the pharmacy database we can identify usage trends, and by implementing simple measures such as early IV-to-oral switching we can help reduce costs.

In the UK, concern over antimicrobial resistance has been growing since the publication in 1998 of reports from the House of Lords Select Committee on Science and Technology and the government’s Standing Medical Advisory Committee. These concerns led to the establishment of a Specialist Advisory Committee on Antimicrobial Resistance (SACAR) in 2001 and the publication in 2002 of Getting Ahead of the Curve, a government strategy to combat infectious disease. However, the incidence of MRSA in UK hospitals has continued to increase, and there is growing concern over the emergence of other resistant species such as Acinetobacter baumannii and extended-spectrum β-lactamase-producing E coli and Klebsiella, as described in this edition. Another antibiotic-related problem is C difficile diarrhoea following treatment with broad-spectrum antibiotics. As the clinical consequences of this are particularly significant in the seriously ill or elderly population, it is a growing problem for hospitals. Here again the prudent use of antibiotics is the key strategy to tackling this problem.

Recognising the contribution hospital pharmacists can make to rational antibiotic prescribing, the Department of Health in the UK has made available additional funding for hospital pharmacies to help tackle the problem. Many hospitals have used this money to create new antibiotic pharmacist posts. As this three-year funding initiative has now ended, I look forward to reading about the outcome of these posts in the columns of this journal in the future. Whatever health system we work in, and irrespective of whether or not our governments provide specific funding, we as hospital pharmacists should be targeting our efforts at antibiotics for the three reasons outlined in this editorial. First, this group of medicines can represent a significant proportion of a hospital’s medicines expenditure. Secondly, as described in this edition, resistance to antibiotics is a growing and serious problem. And finally, overuse of antibiotics can lead to adverse clinical consequences such as C difficile diarrhoea. As antibiotic resistance is likely to be high on most hospital managers’ agenda, now is the ideal time for hospital pharmacists to demonstrate their value by facilitating safe, rational and cost-effective use of this group of medicines.